Navigating Pediatric Diabetes: A Q&A With Leading Expert David Maahs, MD

Diabetes management in pediatric patients has come a long way, with advancements such as continuous glucose monitors and automated insulin delivery systems. In a recent interview, David Maahs, MD, professor of pediatrics and division chief of pediatric endocrinology at Stanford Medicine and Lucile Packard Children’s Hospital Stanford, sheds light on the current state of diabetes care for children and adolescents.

The following Q&A is drawn from Stanford Medcast, Episode 71: Hot Topics Mini Series: Diabetes Unpacked—Myths, Facts, and Tips, a podcast hosted by Ruth Adewuya, MD, CHCP, Managing director of the Stanford Center for Continuing Medical Education.

How has diabetes management for pediatric patients evolved, and what advancements are making a significant impact?

David Maahs, MD: Over time, there has been notable progress in diabetes care for children and adolescents. Continuous glucose monitoring (CGMs) have proven highly effective compared to traditional methods, with approximately 70% to 80% of our patients with type 1 diabetes now utilizing CGMs. Additionally, there are now five approved automated insulin delivery systems, providing diverse options for parents. While not everyone may embrace these technologies immediately, the overall landscape is consistently improving.

What are the primary goals in managing diabetes for pediatric patients, and do these goals vary with age or other factors?

The three main goals in pediatric diabetes care are maintaining a low A1C (a measure of your average glucose over the last three months), minimizing hypoglycemia, and prioritizing a good quality of life. We’ve adapted to use continuous glucose monitoring metrics, focusing on achieving an average glucose or time in range between 70 and 180. Balancing these goals has become more achievable with the advancements in CGMs.

How do acute and long-term complications factor into pediatric diabetes management, and have there been improvements in addressing these concerns?

Acute concerns such as hypoglycemia have improved significantly with continuous glucose monitors and automated insulin delivery systems. For longer-term complications like damage to the eyes, nerves, kidneys, and heart, reducing A1C levels is crucial. The introduction of these new diabetes technologies and lower A1Cs will reduce these risks over time.

Engaging pediatric patients in their care is vital. How does the multidisciplinary team at Stanford Children’s approach this, and what challenges do you most commonly face?

We are fortunate to have a multidisciplinary team at Stanford Medicine Children’s Health, including certified diabetes care and education specialists, dietitians, social workers, psychologists, an exercise physiologist, and pediatric endocrinologists. Diabetes educators play a vital role in educating families, and the team works closely with patients during regular follow-up appointments. The challenges include the 24/7 nature of diabetes management, but continuous support and periodic monitoring help address these difficulties.

Transitioning from pediatric to adult care is a critical phase. How does Stanford Children’s ensure a seamless transition, and what are the key considerations during this process?

Transitioning from pediatric to adult care poses challenges across various health conditions. Our guided transfer program aims to facilitate this transition by introducing patients to adult care while still in the pediatric clinic, ensuring a warm handoff to the adult diabetes clinic. The approach minimizes the risk of patients getting lost during this crucial life phase.

Reflecting on your experience, what are the most rewarding aspects of working with pediatric patients with diabetes?

One of the joys of pediatrics is getting to know the families. Witnessing the growth of children, often entering their lives during a crisis, and seeing them thrive with the advancements in diabetes care is rewarding. The focus is not only medical management, but also on supporting the general well-being and quality of life of these young patients.

The pediatric endocrinology team at Stanford Medicine Children’s Health is ranked in the top 10 in Diabetes & Endocrinology by U.S. News & World Report and treats children with endocrine disorders at convenient locations throughout the Bay Area.